Just The Tip of The Iceberg

In the world of endurance sports, the obsession with eating “perfectly” doesn’t look as abnormal as it might in a crowd of “everyday folks”. The National Association of Anorexia Nervosa and Associated Disorders estimates that ~30 million Americans (~10% of the population), have a diagnosed eating disorder (e.g. anorexia and bulimia). Unfortunately, like an iceberg, the statistics are only the tip of the problem; many more than that show signs of disordered eating and it’s generally believed that the incidence is only rising.

It’s notoriously difficult to measure the prevalence of eating disorders in the athlete community, but it’s generally accepted that the rate is higher than in the general population. One study conducted with elite athletes in Norway found that 13.5% had recognized eating disorders (9% male and 24% female). Athletes are under the same pressures as everyone else to conform to a societal standard of thinness and beauty, but they also struggle with their own special set of risks (i.e. “triggers”). With a cruel twist of irony, those triggers also tend to be the same traits we admire in athletes: the mental focus required to propel the human body to perform ostensibly “superhuman” achievements.

More than once I’ve heard an athlete report on their run mileage logged before their first scheduled meal. It’s a warped point of pride that I know I’m not immune to. I confess I’ve thought to myself: “How many people can run several miles after barely eating for several days?” As I read those words back to myself, my rational mind knows that’s not healthy but making long-lasting change to my disordered thinking patterns a) isn’t a rational exercise to begin with and b) is MUCH easier said than done.

From a coaching perspective, the battle begins with being on the look-out for the early red-flag signs in our athletes. The culture needs to change from seeing these signs as “dedicated” or “grit” to recognizing these behaviors as downright dangerous. In other words, the culture of enablement needs to change…FAST!

Luckily, experts and advocates are currently working to expand the perception of who is exhibiting the signs and symptoms of an eating disorder. Traditionally, the professionals concentrated on the “female athlete triad”. That is, the idea that disordered eating is one of an interconnected set of problems, along with amenorrhea (ceasing to menstruate) and osteoporosis, both of which are common consequences of chronic malnutrition. The downside was that this framework left no room for male athletes, not to mention for some of the worst symptoms of eating disorders, like compromised immunity, heart problems, or organ failure. Given these short comings, the “triad” was completely replaced by the more inclusive term “relative energy deficiency in sport (RED-S)” by 2015.

These days, conversation about eating disorders in endurance sports includes both men’s and women’s voices and instead of focusing on only runners, we’re now hearing the additional testimony of swimmers, cyclists, skiers and even climbers.

While female athletes, like women in general, are indoctrinated from birth with the importance of thinness and feminine slenderness, male athletes are also assaulted with messages about their bodies. Some the cyclists and runners—both men and women—think coaches and directors on women’s teams have grown much more attuned to the issue and now make much more careful with what language they use when it comes to an athlete’s weight or eating habits. Unfortunately, they say, men’s coaches are starting years behind. Given that kind of anecdotal evidence, it’s no surprise that, although eating disorders are almost definitely more common among women, they are still significantly underdiagnosed among males.

In the athlete community, one of the main reasons the pressure to lose weight at all costs persists is because many of those who do also get faster. However, this can only go on for so many seasons. Typically, the benefits of this daredevil strategy burn themselves out, leaving in their wake the devastating long-term consequences of an eating disorder on the body. It may take years—sometimes decades—but the realities of starving for success will catch up with you eventually (and trust me and Chris, it ain’t pretty).

For many athletes (myself included), “recovery” from an eating disorder is about seeking balance and functionality. Personally, when I started trying to address my own eating disorder, I found I would stress about doing it “perfectly,” following my recovery plan to the letter (to the point of obsession). For someone with an eating disorder, structure and discipline can be very important and it is incredibly easy to exchange one disorder for another in an attempt to recover (e.g. anorexia morphs itself into orthorexia). Silencing the inner voice—whom I christened Fluffy early on in an attempt to reduce its power over me—is a tough one for me because I associate anything less than self-criticism as being “too soft” or taking it too easy on myself.

Fluffy is so entwined with my personal identity that I was terrified that losing it would leave me with no personality, no edge, no fire. I think that I, as well as others who live with an eating disorder—must first come to a point of self-acceptance, to learn to say: “It’s okay I still have these triggers [Fluffy]” but to follow that thought with: “I see you Fluffy but I’m busy right now. You and I both know that I need to eat enough to sustain us as an athlete/person and fulfill the goals we are ultimately both striving for.”